Ber Rosalie, Alroy Gideon
Department of Medical Education, B Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Med Teach. 2002 Sep;24(5):528-31. doi: 10.1080/0142159021000012568.
Medical professionalism includes expert knowledge, self-regulation and fiduciary responsibility to place the needs of patients ahead of the self-interest of physicians. In teaching medical professionalism to our medical students only the behavioural elements are dealt with. One of the challenges facing medical educators today is how medical professionalism can be taught. At the authors' faculty of medicine brief videotapes (trigger films) of amateur actor physician-patient encounters in various clinical settings (taken from genuine encounters) are used as a stimulus for discussion and instruction of medical professionalism. A series of 16 trigger films has been produced that raise many medical professional issues. The films and the issues raised are described in brief. These trigger films are viewed by small groups of medical students together with a physician tutor facilitator at various stages of their studies. It is noteworthy how fast the transition occurs in students, from observing the trigger films in their pre-clinical stage as a client, to observing them in their clinical years from the angle of a provider; from identifying with the patient's concerns to identifying with the physicians' behaviour; from being a critical person to becoming a person who accepts the rules and regulations of the guild. Most probably the power of the teaching of ethical and professional rules is overruled by the power of everyday clinical experience during their clinical clerkships. It is planned to run a series of trigger film sessions with senior and junior physicians of the major clerkships, in an attempt to promote an institutional environment/atmosphere/culture of professional behaviour.
医学职业精神包括专业知识、自我约束以及将患者需求置于医生自身利益之上的信托责任。在向医学生传授医学职业精神时，仅涉及行为要素。当今医学教育工作者面临的挑战之一是如何教授医学职业精神。在作者所在的医学院，业余演员在各种临床场景中（取材于真实诊疗过程）进行医患互动的简短录像带（触发影片）被用作讨论和教授医学职业精神的素材。现已制作了一系列16部触发影片，引发了诸多医学职业问题。现将这些影片及引发的问题简要介绍如下。这些触发影片由一小群医学生在学习的不同阶段与一名医生导师共同观看。值得注意的是，学生们的转变速度之快，从临床前阶段作为旁观者观看触发影片，到临床阶段从提供者的角度观看；从认同患者的关切到认同医生的行为；从持批评态度的人变成接受行业规章制度的人。很可能在临床实习期间，日常临床经验的影响力超过了道德和职业规则教学的影响力。计划与主要临床实习科室的 senior 和 junior 医生开展一系列触发影片讨论活动，以营造一种职业行为的机构环境/氛围/文化。 （注：原文中“senior”可能有误，推测应为“senior”，这里按推测翻译为“资深的”，“junior”翻译为“初级的” ）
